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European Review For Medical and... Aug 2023The purpose of the study is to assess the effects of the Epley maneuver on patients with BPPV.
OBJECTIVE
The purpose of the study is to assess the effects of the Epley maneuver on patients with BPPV.
MATERIALS AND METHODS
International libraries such as MEDLINE, Cochrane, Web of Science, and PubMed, among others, were used to evaluate evidence on the effectiveness of Epley's procedure on BPPV published between January 2000 and December 2022. For accessing the articles, several search phrases, such as "Epley Maneuver", "BPPV", "Vertigo", "Vestibular Rehabilitation", and "Physical Therapy" were utilized. A total of 69 papers were retrieved and assessed for inclusion and exclusion criteria based on the article title, abstract, and inclusion and exclusion criteria. Following that, the quality of the chosen studies was assessed using the PEDro scale.
RESULTS
Only seven studies fulfilled the eligibility criterion and were evaluated out of a potential 69 records found. A total of 413 BPPV-screened individuals were examined. The findings of the studies chosen for review revealed that Epley's technique had a considerable, significantly positive influence on the alleviation of symptoms for BPPV patients, including nystagmus, dizziness, and quality of life. The patients described feeling better after performing the Epley maneuver for a prolonged time.
CONCLUSIONS
The research ended with data confirming the benefit of the Epley maneuver in relieving symptoms in BPPV patients.
Topics: Humans; Dizziness; Emotions; Medicine; Patients; Quality of Life; Vertigo; Randomized Controlled Trials as Topic
PubMed: 37667917
DOI: 10.26355/eurrev_202308_33392 -
Otology & Neurotology : Official... Oct 2023To investigate the effect of early vestibular rehabilitation on physical function and dizziness in patients with acute vestibular disorders. (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To investigate the effect of early vestibular rehabilitation on physical function and dizziness in patients with acute vestibular disorders.
DATABASES REVIEWED
The electronic databases examined included PubMed (MEDLINE), Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE (via Dialog), and PEDro.
METHODS
The inclusion criteria in terms of the study participants were patients 20 years and older with an acute unilateral peripheral vestibular disorder. We included individual randomized controlled trials (RCTs), cluster-RCTs, quasi-RCTs, and crossover trials. The outcomes were gait, balance (eyes open, eyes close), activities of daily living, dizziness, and vestibular function. Early vestibular rehabilitation was defined as rehabilitation within 14 days of vestibular disorder onset or surgery. Main outcome measures were gait, balance (eyes open, eyes close), activities of daily living, dizziness, and vestibular function.
RESULTS
Twelve trials involving 542 participants were included. Early vestibular rehabilitation improved the Dizziness Handicap Inventory by -7.18 (95% confidence interval [CI], -10.48 to -3.88), balance during eyes close by -1.40 (95% CI, -2.42 to -0.39), and dizziness by -1.47 (95% CI, -2.74 to -0.21) compared with no intervention or placebo.
CONCLUSION
The present study demonstrated that early vestibular rehabilitation improved the Dizziness Handicap Inventory, balance (eyes close), and subjective dizziness in a patient with acute vestibular disorders. This result indicates that early vestibular rehabilitation can promote vestibular compensation.
Topics: Humans; Dizziness; Vestibular Diseases; Ear Diseases; Vertigo; Databases, Factual
PubMed: 37641214
DOI: 10.1097/MAO.0000000000004006 -
The Laryngoscope Feb 2024To evaluate the extent to which Benign Paroxysmal Positional Vertigo (BPPV) is associated with a higher prevalence of depression and anxiety in patients. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To evaluate the extent to which Benign Paroxysmal Positional Vertigo (BPPV) is associated with a higher prevalence of depression and anxiety in patients.
DATA SOURCES
Three databases including PubMed, Embase, and The Cochrane Library were searched by two independent authors from inception to June 12, 2022 for observational studies and randomized controlled trials investigating the association between BPPV and depression and anxiety. We included studies published as full-length articles in peer-reviewed journals with an adult population aged at least 18 years who have BPPV, detected through validated clinical methods like clinical diagnosis, interview and Dix-Hallpike test.
RESULTS
A total of 23 articles met the final inclusion criteria and 19 articles were included in the meta-analysis. BPPV was associated with a 3.19 increased risk of anxiety compared to controls, and 27% (17%-39%) of BPPV patients suffered from anxiety. Furthermore, the weighted average Beck's Anxiety Inventory score was 18.38 (12.57; 24.18), while the weighted average State-Trait Anxiety Index score was 43.08 (37.57; 48.60).
CONCLUSION
There appears to be some association between BPPV and anxiety, but further studies are required to confirm these associations. Laryngoscope, 134:526-534, 2024.
Topics: Adult; Humans; Adolescent; Benign Paroxysmal Positional Vertigo; Depression; Anxiety; Anxiety Disorders; Databases, Factual
PubMed: 37560919
DOI: 10.1002/lary.30957 -
Artificial Organs Mar 2024Paresis of the upper limb (UL) is the most frequent impairment after a stroke. Hybrid neuroprostheses, i.e., the combination of robots and electrical stimulation, have... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Paresis of the upper limb (UL) is the most frequent impairment after a stroke. Hybrid neuroprostheses, i.e., the combination of robots and electrical stimulation, have emerged as an option to treat these impairments.
METHODS
To give an overview of existing devices, their features, and how they are linked to clinical metrics, four different databases were systematically searched for studies on hybrid neuroprostheses for UL rehabilitation after stroke. The evidence on the efficacy of hybrid therapies was synthesized.
RESULTS
Seventy-three studies were identified, introducing 32 hybrid systems. Among the most recent devices (n = 20), most actively reinforce movement (3 passively) and are typical exoskeletons (3 end-effectors). If classified according to the International Classification of Functioning, Disability and Health, systems for proximal support are expected to affect body structures and functions, while the activity and participation level are targeted when applying Functional Electrical Stimulation distally plus the robotic component proximally. The meta-analysis reveals a significant positive effect on UL functions (p < 0.001), evident in a 7.8-point M between groups in the Fugl-Meyer assessment. This positive effect remains at the 3-month follow-up (M = 8.4, p < 0.001).
CONCLUSIONS
Hybrid neuroprostheses have a positive effect on UL recovery after stroke, with effects persisting at least three months after the intervention. Non-significant studies were those with the shortest intervention periods and the oldest patients. Improvements in UL functions are not only present in the subacute phase after stroke but also in long-term chronic stages. In addition to further technical development, more RCTs are needed to make assumptions about the determinants of successful therapy.
Topics: Humans; Stroke Rehabilitation; Stroke; Upper Extremity; Robotics; Neural Prostheses; Recovery of Function
PubMed: 37548237
DOI: 10.1111/aor.14618 -
Journal of Ethnopharmacology Jan 2024In traditional Chinese medicine, Shen Nong, BenCao Jing, and Compendium of Materia Medica (Bencao Gangmu), Panax ginseng, and its prescriptions have been used for the... (Review)
Review
Ginsenoside Rg1, lights up the way for the potential prevention of Alzheimer's disease due to its therapeutic effects on the drug-controllable risk factors of Alzheimer's disease.
ETHNOPHARMACOLOGICAL RELEVANCE
In traditional Chinese medicine, Shen Nong, BenCao Jing, and Compendium of Materia Medica (Bencao Gangmu), Panax ginseng, and its prescriptions have been used for the treatment of dementia, depression, weight loss, Xiaoke disease (similar to diabetes), and vertigo. All these diseases are associated with the drug-controllable risk factors for Alzheimer's disease (AD), including depression, obesity, diabetes, and hypertension. Ginsenoside Rg1, one of the main active ingredients of P. ginseng and its congener Panax notoginseng, possesses therapeutic potentials against AD and associated diseases. This suggests that ginsenoside Rg1 might have the potential for AD prevention and treatment. Although the anti-AD effects of ginsenoside Rg1 have received more attention, a systematic review of its effects on depression, obesity, diabetes, and hypertension is not available.
AIM OF THE REVIEW
This systematic literature review comprehensively summarized existing literature on the therapeutic potentials of ginsenoside Rg1 in AD prevention for the propose of providing a foundation of future research aimed at enabling the use of such drugs in clinical practice.
METHODS
Information on ginsenoside Rg1 was collected from relevant published articles identified through a literature search in electronic scientific databases (PubMed, Science Direct, and Google Scholar). The keywords used were "Ginsenoside Rg1," "Panax ginseng," "Source," "Alzheimer's disease," "Brain disorders," "Depression," "Obesity," "Diabetes," and "Hypertension."
RESULTS
The monomer ginsenoside Rg1 can be relatively easily obtained and has therapeutic potentials against AD. In vitro and in vivo experiments have demonstrated the therapeutic potentials of ginsenoside Rg1 against the drug-controllable risk factors of AD including depression, obesity, diabetes, and hypertension. Thus, ginsenoside Rg1 alleviates diseases resulting from AD risk factors by regulating multiple targets and pathways.
CONCLUSIONS
Ginsenoside Rg1 has the potentials to prevent AD by alleviating depression, obesity, diabetes, and hypertension.
Topics: Humans; Alzheimer Disease; Ginsenosides; Panax notoginseng; Risk Factors; Obesity
PubMed: 37536646
DOI: 10.1016/j.jep.2023.116955 -
Frontiers in Neurology 2023To systematically evaluate the full spectrum of self-reported chronic symptoms in patients with unilateral vestibular hypofunction (UVH) and to investigate the effect of... (Review)
Review
OBJECTIVE
To systematically evaluate the full spectrum of self-reported chronic symptoms in patients with unilateral vestibular hypofunction (UVH) and to investigate the effect of interventions on these symptoms.
METHODS
A systematic review was conducted following the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis Statement (PRISMA). A literature search was performed in Pubmed, Web of Science, Embase, and Scopus to investigate self-reported symptoms and self-report questionnaires in patients with UVH. All original studies ranging from full-text clinical trials to case reports, written in English, German, and French, were included. The frequency of self-reported symptoms was presented. For self-report questionnaires, a meta-analysis was carried out to synthesize scale means by the pre- and post-intervention means and mean changes for studies that investigated interventions.
RESULTS
A total of 2,110 studies were retrieved. Forty-seven studies were included after title-abstract selection and full-text selection by two independent reviewers. The symptoms of UVH patients included chronic dizziness (98%), imbalance (81%), symptoms worsened by head movements (75%), visually induced dizziness (61%), symptoms worsened in darkness (51%), and oscillopsia (22%). Additionally, UVH could be accompanied by recurrent vertigo (77%), tiredness (68%), cognitive symptoms (58%), and autonomic symptoms (46%). Regarding self-report questionnaires, UVH resulted on average in a moderate handicap, with an estimated mean total score on the Dizziness Handicap Inventory (DHI) and the Vertigo Symptom Scale (VSS) of 46.31 (95% CI: 41.17-51.44) and 15.50 (95% CI: 12.59-18.41), respectively. In studies that investigated the effect of vestibular intervention, a significant decrease in the estimated mean total DHI scores from 51.79 (95% CI: 46.61-56.97) (pre-intervention) to 27.39 (95% CI: 23.16-31.62) (post intervention) was found ( < 0.0001). In three studies, the estimated mean total Visual Analog Scale (VAS) scores were 7.05 (95% CI, 5.64-8.46) (pre-intervention) and 2.56 (95% CI, 1.15-3.97) (post-intervention). Finally, a subgroup of patients (≥32%) persists with at least a moderate handicap, despite vestibular rehabilitation.
CONCLUSION
A spectrum of symptoms is associated with UVH, of which chronic dizziness and imbalance are most frequently reported. However, semi-structured interviews should be conducted to define the whole spectrum of UVH symptoms more precisely, in order to establish a validated patient-reported outcome measure (PROM) for UVH patients. Furthermore, vestibular interventions can significantly decrease self-reported handicap, although this is insufficient for a subgroup of patients. It could therefore be considered for this subgroup of patients to explore new intervention strategies like vibrotactile feedback or the vestibular implant.
SYSTEMATIC REVIEW REGISTRATION
[https://www.crd.york.ac.uk/prospero/], identifier [CRD42023389185].
PubMed: 37483440
DOI: 10.3389/fneur.2023.1177314 -
Neurosurgical Review Jul 2023The dentato-rubro-olivary pathway, also known as the Guillain-Mollaret triangle (GMT) or myoclonic triangle, consists of the dentate nucleus, the red nucleus, and the... (Review)
Review
The dentato-rubro-olivary pathway, also known as the Guillain-Mollaret triangle (GMT) or myoclonic triangle, consists of the dentate nucleus, the red nucleus, and the inferior olivary nucleus (ION). GMT is important for motor coordination and control, and abnormalities in this network can lead to various neurological disorders. The present study followed a systematic approach in conducting a review on GMT studies. The inclusion criteria were limited to human subjects with primary objectives of characterizing and evaluating GMT syndromes, and the methodology used was not a determining factor for eligibility. The search strategy used MeSH terms and keywords relevant to the study's objective in various databases until August 2022. A total of 76 studies were included in the review after assessing 527 articles for eligibility based on the final inclusion criteria. Most of the studies evaluated the GMT in human subjects, with the majority utilizing magnetic resonance imaging (MRI), diffusion tensor imaging (DTI), or combination of them. The review found that Hypertrophic olivary degeneration (HOD), a common consequence of GMT damage, has diverse underlying causes, including stroke, brainstem cavernous malformations, and structural impairments. Palatal tremor, ocular myoclonus, ataxia, nystagmus, and vertigo were frequently reported symptoms associated with HOD. This systematic review provides comprehensive insights into the association between GMT and various neurological syndromes, shedding light on the diagnostic, etiological, and prognostic aspects of GMT dysfunction. Understanding the role of the GMT and its implications in movement disorders could pave the way for improved treatment options and better management of neurological conditions related to this critical brainstem pathway.
Topics: Humans; Diffusion Tensor Imaging; Syndrome; Olivary Nucleus; Magnetic Resonance Imaging; Stroke; Hypertrophy
PubMed: 37468768
DOI: 10.1007/s10143-023-02086-1 -
Journal of the American Medical... Nov 2023Falls are common among older people in nursing homes, and the assessment of fall risk factors is critical for the success of fall prevention interventions. This study... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Falls are common among older people in nursing homes, and the assessment of fall risk factors is critical for the success of fall prevention interventions. This study aimed to systematically assess the incidence and risk factors of falls in older people living in nursing homes.
DESIGN
Systematic review and meta-analysis.
SETTING AND PARTICIPANTS
Older people living in nursing homes.
METHODS
Literature searches were conducted independently by 2 researchers in 8 databases. Qualities of included studies were assessed using the Newcastle-Ottawa Scale. The prevalence and risk factors of falls were analyzed with a random effects model. All analyses were performed by R software, x64 4.2.2.
RESULTS
In 18 prospective studies addressing older adults living in nursing homes, the pooled incidence of falls was 43% (95% CI 38%-49%), and the meta-regression analysis indicated that the incidence generally decreased from 1998 to 2021. The following risk factors had a strong association with all falls: fall history, impaired ADL performance, insomnia, and depression. Risk factors with low to moderate correlation were vertigo, walking aids, poor balance, use of antidepressants, use of benzodiazepines, use of antipsychotics, use of anxiolytics, polypharmacy, dementia, unsteady gait, hearing problems, and gender (being male). Having bed rails was identified as a protective environmental factor.
CONCLUSIONS AND IMPLICATIONS
The results from our meta-analysis suggest that the incidence of falls of older adults living in nursing homes is high, and the risk factors for falls are various. Assessments of balance and mobility, medical condition, and use of medications should be included as key elements in the fall risk assessments of older people in nursing homes. Environmental risk factors still need to be explored in future studies. Tailored fall prevention strategies should be implemented by addressing the modifiable risk factors.
Topics: Humans; Male; Aged; Female; Accidental Falls; Incidence; Prospective Studies; Nursing Homes; Risk Factors
PubMed: 37433427
DOI: 10.1016/j.jamda.2023.06.002 -
Frontiers in Neurology 2023For the assessment of patients presenting with acute prolonged vertigo meeting diagnostic criteria for acute vestibular syndrome (AVS), bedside oculomotor examinations...
OBJECTIVES
For the assessment of patients presenting with acute prolonged vertigo meeting diagnostic criteria for acute vestibular syndrome (AVS), bedside oculomotor examinations are essential to distinguish peripheral from central causes. Here we assessed patterns of spontaneous nystagmus (SN) observed in AVS and its diagnostic accuracy at the bedside.
METHODS
MEDLINE and Embase were searched for studies (1980-2022) reporting on the bedside diagnostic accuracy of SN-patterns in AVS patients. Two independent reviewers determined inclusion. We identified 4,186 unique citations, examined 219 full manuscripts, and analyzed 39 studies. Studies were rated on risk of bias (QUADAS-2). Diagnostic data were extracted and SN beating-direction patterns were correlated with lesion locations and lateralization.
RESULTS
Included studies reported on 1,599 patients, with ischemic strokes ( = 747) and acute unilateral vestibulopathy ( = 743) being most frequent. While a horizontal or horizontal-torsional SN was significantly more often found in peripheral AVS (pAVS) than in central AVS (cAVS) patients (672/709 [94.8%] vs. 294/677 [43.4%], < 0.001), torsional and/or vertical SN-patterns were more prevalent in cAVS than in pAVS (15.1 vs. 2.6%, < 0.001). For an (isolated) vertical/vertical-torsional SN or an isolated torsional SN specificity (97.7% [95% CI = 95.1-100.0%]) for a central origin etiology was high, whereas sensitivity (19.1% [10.5-27.7%]) was low. Absence of any horizontal SN was more frequently observed in cAVS than in pAVS (55.2 vs. 7.0%, < 0.001). Ipsilesional and contralesional beating directions of horizontal SN in cAVS were found at similar frequency (28.0 vs. 21.7%, = 0.052), whereas for pAVS a contralesional SN was significantly more frequent (95.2 vs. 2.5%, < 0.001). For PICA strokes presenting with horizontal SN, beating direction was ipsilesional more often than contralesional (23.9 vs. 6.4%, = 0.006), while the opposite was observed for AICA strokes (2.2 vs. 63.0%, < 0.001).
CONCLUSIONS
(Isolated) vertical and/or torsional SN is found in a minority (15.1%) of cAVS patients only. When present, it is highly predictive for a central cause. A combined torsional-downbeating SN-pattern may be observed in pAVS also in cases with isolated lesions of the inferior branch of the vestibular nerve. Furthermore, in cAVS patients the SN beating direction itself does not allow a prediction on the lesion side.
PubMed: 37396773
DOI: 10.3389/fneur.2023.1208902 -
Frontiers in Neural Circuits 2023Space Motion Sickness (SMS) is a syndrome that affects around 70% of astronauts and includes symptoms of nausea, dizziness, fatigue, vertigo, headaches, vomiting, and...
INTRODUCTION
Space Motion Sickness (SMS) is a syndrome that affects around 70% of astronauts and includes symptoms of nausea, dizziness, fatigue, vertigo, headaches, vomiting, and cold sweating. Consequences range from discomfort to severe sensorimotor and cognitive incapacitation, which might cause potential problems for mission-critical tasks and astronauts and cosmonauts' well-being. Both pharmacological and non-pharmacological countermeasures have been proposed to mitigate SMS. However, their effectiveness has not been systematically evaluated. Here we present the first systematic review of published peer-reviewed research on the effectiveness of pharmacological and non-pharmacological countermeasures to SMS.
METHODS
We performed a double-blind title and abstract screening using the online Rayyan collaboration tool for systematic reviews, followed by a full-text screening. Eventually, only 23 peer-reviewed studies underwent data extraction.
RESULTS
Both pharmacological and non-pharmacological countermeasures can help mitigate SMS symptoms.
DISCUSSION
No definitive recommendation can be given regarding the superiority of any particular countermeasure approach. Importantly, there is considerable heterogeneity in the published research methods, lack of a standardized assessment approach, and small sample sizes. To allow for consistent comparisons between SMS countermeasures in the future, standardized testing protocols for spaceflight and ground-based analogs are needed. We believe that the data should be made openly available, given the uniqueness of the environment in which it is collected.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021244131.
Topics: Humans; Randomized Controlled Trials as Topic; Space Flight; Space Motion Sickness; Vestibule, Labyrinth; Weightlessness
PubMed: 37396400
DOI: 10.3389/fncir.2023.1150233